Do subcutaneous sutures increase risk of laparotomy wound suppuration?
Authors: Coomer R P C, Mair T S, Edwards G B, Proudman C J
Journal: Equine veterinary journal
Summary
# Editorial Summary: Subcutaneous Sutures and Equine Laparotomy Wound Complications Post-operative wound drainage and infection remain frequent complications following exploratory abdominal surgery in horses, prompting investigation into whether omitting subcutaneous sutures during closure might reduce suppuration rates. Coomer and colleagues conducted a randomised controlled trial across two UK referral hospitals comparing traditional three-layer closure (with subcutaneous sutures) against simplified two-layer closure in 309 horses undergoing exploratory laparotomy; wound observations were recorded daily in-hospital, with telephone follow-up continuing for at least 30 days post-discharge. Suppuration prevalence was 18.7% in two-layer closures versus 23.9% in three-layer closures—a difference that failed to reach statistical significance (P = 0.263)—with no catastrophic wound failures documented in either group. These findings suggest that eliminating the subcutaneous suture layer does not compromise closure integrity or increase infection risk, and may offer practical benefits through simplified surgical technique and reduced foreign material at the incision site. Two-layer closure represents a safe, evidence-based alternative for ventral midline closure in equine abdominal surgery.
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Practical Takeaways
- •You can safely omit subcutaneous sutures in laparotomy closure without increasing infection risk—in fact, there was a trend toward fewer complications
- •Two-layer closure reduces operative time and materials without compromising wound healing outcomes
- •Consider switching to two-layer closure as standard practice for routine exploratory laparotomies in your hospital
Key Findings
- •Two-layer closure without subcutaneous sutures showed 18.7% suppuration rate compared to 23.9% in conventional three-layer closure (OR = 1.37, P = 0.263)
- •No significant difference in prevalence or rate of wound suppuration between two-layer and three-layer closure methods
- •No catastrophic failures of two-layer closures were recorded during the study period
- •Two-layer closure is a safe alternative to conventional three-layer closure for ventral midline abdominal closure in horses